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General NPI Number Information
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NPI Number | 1720501943
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Entity Type | Organization
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Legal Business Name | BIG TREE PARTNERS LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 2814 INDIAN WELLS RD
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City | ALAMOGORDO
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State | NM
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Zip | 88310-3861
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Country | US
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Telephone | 575-415-1927
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 INDIAN WELLS RD
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City | ALAMOGORDO
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State | NM
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Zip | 88310-3861
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER/MANAGER
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Name | MR. ROBERT C WILTSHIRE
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Credential |
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Telephone | 919-349-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-01499
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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